Healthcare Provider Details

I. General information

NPI: 1912861659
Provider Name (Legal Business Name): MARGARET HAGNAUER EASTBURN PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2229 TRESTLE RD
FORT COLLINS CO
80525-6816
US

IV. Provider business mailing address

2229 TRESTLE RD
FORT COLLINS CO
80525-6816
US

V. Phone/Fax

Practice location:
  • Phone: 970-310-4591
  • Fax:
Mailing address:
  • Phone: 970-310-4591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN0154762
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: